Institutionalizing postpartum intrauterine device (IUD) services in Sri Lanka, Tanzania, and Nepal: study protocol for a cluster-randomized stepped-wedge trial

Abstract

BackgroundDuring the year following the birth of a child, 40% of women are estimated to have an unmet need for contraception. The copper IUD provides safe, effective, convenient, and long-term contraceptive protection that does not interfere with breastfeeding during the postpartum period. Postpartum IUD (PPIUD) insertion should be performed by a trained provider in the early postpartum period to reduce expulsion rates and complications, but these services are not widely available. The International Federation of Obstetricians and Gynecologists (FIGO) will implement an intervention that aims to institutionalize PPIUD training as a regular part of the OB/GYN training program and to integrate it as part of the standard practice at the time of delivery in intervention hospitals.MethodsThis trial uses a cluster-randomized stepped wedge design to assess the causal effect of the FIGO intervention on the uptake and continued use of PPIUD and of the effect on subsequent pregnancy and birth. This trial also seeks to measure institutionalization of PPIUD services in study hospitals and diffusion of these services to other providers and health facilities. This study will also include a nested mixed-methods performance evaluation to describe intervention implementation.DiscussionThis study will provide critical evidence on the causal effects of hospital-based PPIUD provision on contraceptive choices and reproductive health outcomes, as well as on the feasibility, acceptability and longer run institutional impacts in three low- and middle-income countries.Trial registrationTrial registered on March 11, 2016 with ClinicalTrials.gov, NCT02718222.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1160-0) contains supplementary material, which is available to authorized users.

Acceptability and factors associated with post-partum IUCD use among women who gave birth at bale zone health facilities, Southeast-Ethiopia

“…Immediate PPIUCD insertion does not require repeated health care visits for contraceptive refills [4]. The insertion of immediate PPIUCD is easy and safe when compared with delayed postpartum and interval insertion of the intrauterine contraceptive device (IUCD) [5] and it can be initiated by a mid-level skilled birth attendant [6]. …”

“Cross-sectional” stepped wedge designs always reduce the required sample size when there is no time effect

“…PROGRESA was a conditional cash transfer program targeting the country’s poorest families, providing them with financial incentives for uptake of recommended public health and nutrition practices and for keeping children in school, which was evaluated through a staggered roll-out of these policies among 495 communities [6]. Finally, soon to complete in Nepal, Tanzania, and Sri Lanka, an SWD to assess the effectiveness of postpartum intrauterine device insertion as a safe and acceptable means of preventing unintended pregnancy closely following a current birth, the FIGO study, is running for a 1-year enrollment period of a projected 64,000 pregnant women, each with 1.5 years of follow-up [7]. …”

Institucionalización de la planificación familiar posparto y del dispositivo intrauterino posparto en Nepal: papel de la formación y la tutoría

“…En ello juegan un papel fundamental los profesionales sanitarios, ofreciendo el DIUPP a las mujeres en el momento apropiado y a través de un servicio de calidad 5,6 . Sin embargo es crucial mantener los estándares clínicos, para lo cual se necesita ofrecer una formación y unos servicios de tutoría de buena calidad 7,8 .…”